Case Description—A 3.5-year-old spayed female Labrador Retriever was examined for dysuria of unknown duration.
Clinical Findings—Urogenital examination revealed a recessed vulva and a persistent hymen. The hymen was broken down digitally. Results of urinalysis at the referral examination were unremarkable, and no clinically relevant abnormalities were detected on clinicopathologic analysis of blood and serum samples or cytologic evaluation of a vaginal smear. After clinical signs persisted, retrograde contrast vaginourethrocystography was performed; results were considered normal. During uroendoscopic examination, a translucent membranous structure was detected that partially obstructed the urethral lumen near the junction of the urethra and bladder.
Treatment and Outcome—Passage of the endoscope into the urinary bladder ruptured the membranous structure. The dog recovered from the procedure uneventfully and was treated with colchicine (0.03 mg/kg [0.014 mg/lb], PO, q 24 h for 14 days). One month later, the owner reported resolution of clinical signs. Fourteen months later, the patient was evaluated for recurrence of dysuria of several months' duration. Uroendoscopic examination revealed a membranous structure similar to that originally detected; this tissue was also ruptured during endoscopy. The patient was discharged and the owner was instructed to administer colchicine at the same dosage. Recurrence of dysuria was reported again 10 months following the second procedure.
Clinical Relevance—To the authors' knowledge, this type of membranous urethral obstruction has not been previously described in a dog. Administration of colchicine did not prevent recurrence, but potential effects of drug administration on time to recurrence could not be evaluated.
Case Description—A 5-year-old 34.3-kg (75.5-lb) neutered male German Shepherd Dog was evaluated because of chronic azotemia that was unresponsive to typical medical management.
Clinical Findings—Urinalysis revealed pyuria and fungal hyphae. Fungal culture of a urine sample grew a sterile mold that was identified as Westerdykella spp via PCR assay.
Treatment and Outcome—The dog was treated empirically with itraconazole orally and amphotericin B IV for 5 weeks. Because of progressive azotemia, treatment was modified to oral administration of posaconazole. The dog improved but then developed progressive azotemia, hyperphosphatemia, and suspected diskospondylitis. Treatment was again modified to oral administration of terbinafine on the basis of results of antifungal susceptibility testing. The dog was euthanized after 5 months of antifungal treatment because of a deteriorating clinical condition and progressive azotemia.
Clinical Relevance—Westerdykella spp are filamentous hyphal organisms from the family Sporomiaceae and had not previously been reported to cause infections in dogs. Fungal PCR assay and antifungal susceptibility testing may be useful for a patient with a suspected fungal infection that does not respond to empirical treatment or when traditional culture methods for fungal identification are unsuccessful. Westerdykella spp should be considered as a possible etiologic agent when systemic mycosis is diagnosed.
Case Description—A 6-year-old male castrated Shetland Sheepdog was evaluated because of severe hypokalemia and progressive paresis.
Clinical Findings—Physical examination revealed fever, tachypnea, mydriasis, hyperemic mucous membranes, severe forelimb paresis, and hind limb paraplegia. The dog had superficial and deep pain sensation in all 4 limbs. Forelimb spinal reflexes were considered normal, but hind limb reflexes were normal to slightly hyperreflexive. The panniculus reflex was considered to be normal, and cranial nerve reflexes were intact. A CBC revealed mild leukocytosis and erythrocytosis, and serum biochemical analysis revealed severe hypokalemia. Thoracic and abdominal imaging did not reveal relevant findings. Blood pressure and ECG findings were within reference limits. Questioning of the owner revealed possible exposure to albuterol via ingestion of medication intended for the owner's horse. Results of serum testing via immunoassay were suggestive of albuterol toxicosis.
Treatment and Outcome—Treatment included IV administration of an electrolyte solution and supplemental potassium chloride. The rate of potassium chloride supplementation was slowly decreased as serum potassium concentration increased. No other medical intervention was required, and the dog made a rapid and complete recovery.
Clinical Relevance—Ingestion of albuterol can lead to profound physical and serum biochemical abnormalities. Appropriate historical information should be obtained to identify possible sources and routes of exposure to intoxicants. Albuterol-induced hypokalemia can be successfully managed medically.
To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation-volvulus (GDV) and to compare findings with those of trocarization.
16 dogs with GDV.
Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups.
The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively. After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks.
CONCLUSIONS AND CLINICAL RELEVANCE
Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.
OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter.
ANIMALS 6 healthy male large-breed dogs.
PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours.
RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery.
CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.